Hospitalisation Cover

Hospital cover is a part of health insurance that helps you get comprehensive financial coverage for the costs included under hospitalisation. By opting for basic a hospital cover insurance, in case of any medical emergency, you are treated as a private patient and allotted a dedicated ward. The costs like in-hospital treatment, accommodation fees,surgery fees and all those expenses associated with hospitalisation. You can avail the benefit of getting admitted to the network hospitals that we have, spread across the country, along with a provision of cashless hospitalisation. The only mandatory thing is that the hospitalisation needs to be at least 24 hours from the time of admission.

ManipalCigna offers you two different plans with private hospital cover and a bunch of benefits. You get in-patient hospitalisation cover through which all the room charges, nursing charges, ICU charges, surgeon as well as doctor fees, operation theatre, blood and oxygen and several other medical expenses are covered. ManipalCigna is beneficial too as it covers not just hospitalisation charges under basic hospital cover, but also offer you financial backup for several other costs. The ProHealth plan covers pre as well as post hospitalisation costs such as medical expenses made during the recovery process of 30 days. If the treatment you undergo needs less than 24 hours, 500 plus day-care procedures are made available under the plan. If the bed vacancy is nil or if you are unable to reach the hospital due to severe conditions, you can get domiciliary treatment at your home. Many times, hospital cover doesn’t include ambulance charges; however, ManipalCigna offers it to you at your convenience. Transportation expenses by an ambulance are also important while considering medical emergencies. Maternity and new-born medical costs are also taken care of under the basic hospital cover of ManipalCigna. Along with regular coverage, ManipalCigna private hospital cover also includes health check- ups, expert opinions on critical illnesses, and so on.

ManipalCigna offers affordable hospital cover along with a wide range of benefits. Here is the list of applications that you are entitled to get under the policy-  All in-patient hospitalisation, along with pre and post-hospitalisation expenses.  Day-care treatment for hospitalisation with less than 24 hours.  Donor Expenses covering the cost of organ and transplant expenses.  AYUSH cover, which is nothing but any treatment falling under Ayurveda, Yoga & Naturopathy, Unani, Siddha & Homeopathy treatment for the event occurred due to illnesses or accidents.  Maternity expenses, along with new-born medical expenses and first-year vaccination charges, are covered under ManipalCigna’s affordable hospital cover.  Health check-ups and expert opinion on critical illness  You can also opt for a critical illness rider with the hospital cover you have chosen.  Several discounts such as a long-term discount, family discount, co-pay discount, cancellation provision are also available with tax benefits.

Though ManipalCigna provides one of the best hospital covers of its kind, there are certain exclusions which you need to consider.
 Hospitalisation due to HIV/AIDS and its complications is not covered under hospital cover insurance.
 Hospitalisation happened due to drug abuse or an act of suicide.
 Any disease occurred by contamination from nuclear fuel or radiation is not covered.
 Any injury due to act of foreign invasion or civil war is excluded from hospital cover.

Pre-hospitalization expenses are those expenses that you incur before you are admitted into a hospital. Typically, when you fall ill, you first visit your family doctor, who may ask you to undergo a series of medical tests. Based on the test results, the doctor may advice you to visit a specialist, who may diagnose your condition and explain the course of treatment. In case your condition is severe, the specialist may suggest that you undergo hospitalization, and possibly, a minor or major surgery to help you recover from the illness.

In the process of diagnosing your medical condition, these costs before you are even hospitalized can build up and multiply significantly. But with your ManipalCigna Health Insurance policy that covers pre-hospitalization costs, you can file a claim for these expenses and get them reimbursed.

Once you are discharged from the hospital, especially following a severe illness, your physician may ask you to undergo another round of tests, or a series of tests every few days. They may also recommend follow-up consultations to monitor whether your condition is improving, and if you may need another round of hospitalization. The expenses incurred after you are discharged from the hospital are therefore categorized as post-hospitalization expenses.

With your ManipalCigna Health Insurance Plan, you can file a post-hospitalization claim for the costs incurred after being discharged from the hospital. The post-hospitalization expenses you incur should be related to the medical condition for which you were hospitalized, and not for other costs.

You can file a claim to get reimbursement for the following pre-and post-hospitalization expenses:

Pre-Hospitalization consultations	Blood tests	Urine tests
X-rays	PET and CT scans	MRIs
Ambulance charges	Biopsies	Histopathology reports
Physiotherapy sessions	Dialysis and similar treatments	Radiation and chemotherapy
Follow-up consultations	Suture removal procedures	Other medical screenings

You can file a claim for pre and post-hospitalization coverage with ManipalCigna Health Insurance by following these five simple steps:

1. Check the timelines mentioned in your ManipalCigna Health Insurance policy to file pre and post-hospitalization claims.
2. Fill out the claim form (for reimbursement claims) or provide the claim ID (for cashless claims). You can visit your health insurance policy page and download the applicable form.
3. Review the list of documents required as mentioned in the claim form and submit them, proving the pre and post-hospitalization expenses incurred by you.
4. ManipalCigna shall verify your claim and assess if the costs for which you are claiming reimbursement are connected to the medical condition for which you were hospitalized.
5. After verifying your claim and finding it valid, we shall reimburse you for the pre and post-hospitalization expenses up to the sum insured applicable to your health insurance policy.

If all your documents are in order, you can expect to receive reimbursement for your expenses within a span of 21 working days. You can also follow up with us via calls or emails to know the claim status.

Remember to consider the following factors while filing a pre and post-hospitalization claim with ManipalCigna Health Insurance:

• You can claim pre-hospitalization expenses of up to 30 days before you are admitted in a hospital for treatment.
• You can file a post-hospitalization claim for expenses incurred in the 45-90 days window after you are discharged from the hospital.
• You must check the list of required documents and submit all original bills and receipts proving the costs incurred, as well as photocopies of medical reports.
• You can claim reimbursement for pre and post-hospitalization costs only for the medical condition for which you were admitted in the hospital.
• While filing a reimbursement claim for pre and post-hospitalization expenses, you must check the applicable timelines set by ManipalCigna and follow them strictly.
• You can file the claim for both pre and post-hospitalization expenses at the same time, after you have been discharged from the hospital.
• ManipalCigna will reimburse you for the pre and post-hospitalization costs only if you have not exhausted the sum insured applicable to your hospital health cover plan.
• If your insurance policy includes domiciliary hospitalization coverage, you can file a claim for the same as part of post-hospitalization coverage.
• You can get pre and post-hospitalization coverage as part of your existing medical insurance policy or purchase it as a separate add-on rider.
• Your claim may be rejected if you fail to provide all the documents listed in the claim form, proving the pre and post-hospitalization expenses incurred by you.
• Failure to adhere to the timelines for filing pre and post-hospitalization claims can also result in your claim being rejected on the grounds of non-compliance of rules.

Your ManipalCigna Health Insurance plan with pre and post-hospitalization cover gives you access to these unparalleled benefits:

• All-around coverage: The pre and post-hospitalization plan allows you to seek coverage for various expenses incurred during treatment, and not just the hospitalization-related costs.
• Variety of tests covered: You can file claims and get reimbursed for all kinds of medical diagnostic tests recommended by various physicians during the treatment period.
• Coverage window: The coverage window for pre-hospitalization period is usually 30 days, while you can claim post-hospitalization expenses for up to 90 days after being discharged.
• Cashless coverage: If you seek treatment at a network hospital, you can enjoy cashless coverage benefits, specifically related to the pre and post-surgery tests run by the hospital.
• Reimbursement of expenses: Your pre and post-hospital health cover also includes a provision to seek treatment at your preferred hospital and file a reimbursement claim after discharge.
• Peace of mind: Since the pre and post-hospitalization cover takes care of all the medical costs you can focus on getting the necessary treatment instead of worrying about the expenses.
• Follow-up costs: In case you need to undergo a follow-up consultation that also includes a minor procedure, such as the removal of sutures or stitches, the costs of the same are covered.

While filing a claim for pre and post-hospitalization cover with Manipal Cigna Health Insurance, you must ensure you submit all the applicable documents listed in the claim form, including:

• The duly-filed and signed claim form comprising details like your name, age, date of birth, e-mail ID, insurance policy number, hospital name, etc.
• Self-attested copies of your age, ID, and address proof documents for verification purposes. You must check the claim form to find the list of the officially accepted documents.
• A copy of the doctor’s prescription note suggesting that you need treatment in the hospital.
• Copies of doctor’s prescriptions advising you to undergo the necessary diagnostic tests, medications, or consultations from specialists.
• All original bills showcasing the costs accrued before and after being hospitalized such as doctor consultation receipts, bills issued by pharmacies and diagnostic laboratories.
• Copies of all your medical reports and records provided by laboratories in the pre and post-hospitalization phase of the treatment course.
• Original receipts showing that you utilised ambulance services in the pre and post-hospitalization phase.
• A photocopy of the First Information Report (FIR), in case the hospitalization was caused due to an accident or a non-medical reason.
• Any other documents as may be requested by the claim settlement team at ManipalCigna Health Insurance from time to time, during the claim processing period.

*Pl note the claim documents may vary as per the case.

The way pre and post-hospitalization coverage works is very simple. It essentially entails coverage for all the costs associated with hospitalization and not just the treatment provided in a hospital setting.

Your insurer understands that medical treatments may extend the four walls of the hospital and that you have to bear several expenses like undergoing tests, visiting specialists, taking second and third opinions from medical professionals whether hospitalization is necessary or avoidable, etc.

Moreover, after hospitalization, you may need to monitor your health; whether it is improving or if you need additional treatment. To check the same, you may need to undergo another round of tests. In doing all this, the costs can mount up significantly, which is why your insurance policy covers you against these costs.

Besides the pre and post-hospitalisation coverage you can claim, your Manipal Cigna Health Insurance policy also covers a variety of actual hospitalization-related expenses, from the moment you are hospitalized until you are discharged. The scope of coverage includes:

• Costs of renting a hospital room, up to a specific sub-limit based on your chosen health plan.
• Costs associated with ICU stays (as per actuals), based on your physician’s recommendations.
• Fees levied by the treating and visiting physicians, such as surgeons, anaesthesiologists, specialists, physiotherapists, dieticians, etc.
• Expenses incurred during the actual surgery such as the use of medications, injections, and special equipment (catheters, artificial valves, sutures, etc.,) necessary for the treatment.
• Costs incurred by the hospital staff to nurse the patient back to health in the general rooms and/or ICU.
• Expenses associated with providing you meals during your stay in the hospital.
• Costs of various domiciliary treatments at home as well as day-care procedures that do not warrant overnight hospitalization.
• Charges incurred as a result of using a donor during an organ transplantation procedure.

What does hospitalization insurance typically cover?

Hospitalization insurance typically covers all the costs incurred when you are admitted in a hospital. These costs could range from renting a hospital room, days spent in the ICU, the cost of medicines provided during the hospital stay, meal expenses, and medical fees associated with the surgeon and their team of medical experts like nurses, anaesthesiologists, physiotherapists, dieticians, among other things. Besides the actual stay in the hospital, hospitalization cover also covers pre and post-hospitalization costs such as medical tests and screenings, X-rays, biopsy and histopathology costs, as well as expenses incurred after you are discharged from the hospital, such as follow-up consultations and medical tests.

Can I seek treatment in any hospital of my choice under hospitalization coverage?

Yes, you can choose to seek treatment in any of your preferred hospitals. You would be eligible for hospitalization coverage irrespective of whether you choose to be treated at a hospital under your insurer’s network (on a cashless basis), or if you decide to seek treatment in a non-network hospital where you are comfortable. However, opting for treatment at a hospital within your insurer’s network proves more beneficial as the insurer’s representative manages the billing and claim-related formality by directly dealing with the hospital staff.  

What are the typical costs covered under pre hospitalization?

Pre-hospitalization refers to any tests or medical screenings you need to undergo before you are admitted to the hospital for surgery or treatment. The costs associated with these tests fall under the broad umbrella of pre-hospitalization costs. Examples of pre-hospitalization costs include blood and urine tests, allergy tests, MRIs, CT scans, PET scans, X-rays, doctor consultation fees, and so on.

How can I file a claim for my post-hospitalization expenses?

To file a claim for your post-hospitalization expenses, you first need to collect all the vital documents such as doctor consultation receipts, prescriptions given by the doctor (including the tests suggested), receipts of the medical tests you’ve undergone, prescriptions and receipts of follow-up treatment courses suggested by your doctor, etc., You must then submit these documents to your insurer with either the duly-filed claim form (in case of a reimbursement claim) and/or the claim ID (in case of cashless claims). The insurer will verify the submitted details and reimburse you for the costs.

When does the insurer not accept pre and post hospitalization claims?

Insurers typically do not accept your pre and post hospitalization claims under the following circumstances:

• If you file the claim after the mandated claim-filing period, which is typically 45-90 days after hospitalization.
• If they notice that the claims filed by you were for a different treatment and had nothing to do with the reason for which you were hospitalized.
• If they find that the documents you submitted were wrong, incomplete, or had something missing.

Do you have to get a pre and post hospitalization cover separately?

Pre and post-hospitalization cover is generally included under most health insurance policies in India, and in most cases, you do not need to purchase the cover separately. However, you must check your insurance policy agreement, and if this coverage is not included as part of it, you can either choose a policy that includes this cover or purchase the cover as a separate add-on rider, by paying a little extra.

Can I file a claim for ayurvedic treatments under post hospitalization expenses?

Yes, per the IRDAI mandate, your insurance provider is mandated to cover AYUSH treatments, which includes Ayurveda, as part of insurance coverage. While you can get post-hospitalization coverage for Ayurvedic treatments, you must check if you are eligible for other non-allopathic or Ayurvedic treatments (e.g.. Yoga, Unani, Siddha and Homeopathy) under both, pre and post-hospitalization cover.

Can I buy a pre-hospitalization and post hospitalization cover online?

Yes, you can buy all kinds of health insurance policies and different types of insurance covers, including pre and post-hospitalization covers online. You can do so by visiting the official website of your chosen insurer, downloading and filling the application form and submitting soft copies of the requested documents (as mentioned in the claim form). You can then pay for the policy by choosing your preferred online payment method. After receiving your application, the insurer typically mails you the policy instantly on your email address. In some cases, you may need to undergo a medical test after which your insurer releases the policy.